Normally, the kidneys filter waste products and water from the blood to form urine, which is stored in the bladder . When the bladder is full, a message is sent from the bladder to the brain. The brain sends a message back to the bladder to squeeze the bladder muscle and relax the sphincter muscles that control the flow of urine. After the bladder starts to empty, it normally empties all of the urine.
After an SCI, the kidneys usually continue to filter waste, and urine is stored in the bladder. But messages may not be able to move between your bladder and sphincter muscles and your brain. This can result in the:
- Inability to store urine. You cannot control when your bladder empties (reflex incontinence). This is known as reflex or spastic bladder.
- Inability to empty the bladder. Your bladder is full, but you can't empty it. It stretches as it continues to fill with urine, which can cause damage to the bladder and kidneys. This is known as a flaccid bladder.
Not taking good care of your bladder can lead to urinary tract infections (UTIs), kidney and bladder problems, sepsis (a bloodstream infection), and, in rare cases, kidney failure. For information on testing for, treating, and preventing UTIs, see the topic Urinary Tract Infections in Teens and Adults.
A bladder management program lets you or a caregiver empty your bladder when it is easy for you and helps you avoid bladder accidents and prevent UTIs. You and your rehabilitation team decide which bladder management program is best for you. You need to consider where your spinal cord is injured and how it has affected your bladder function. You also need to consider your lifestyle, how likely you are to get bladder infections, and whether you or a caregiver is able to use a catheter.
The most important things in bladder management are monitoring the amount of fluids you drink, following a regular schedule for emptying your bladder, and being sure that you empty your bladder completely. Your rehab team will help you set up a schedule based on your needs and the amount of fluids you typically drink.
Common ways to manage bladder function include the following:
- Intermittent catheterization programs (ICPs) are often used when you have the ability to use a catheter yourself or someone can do it for you. You insert the catheter-a thin, flexible, hollow tube-through the urethra into the bladder and allow the urine to drain out. It is done at scheduled times, and the catheter isn't permanent.
- If you can't use intermittent catheterization, you can use a permanent catheter known as an indwelling Foley catheter . Urinary tract infections are more likely to occur with long-term use of an indwelling catheter than with an ICP. Caring for the catheter is important to avoid infections.
- If you use an indwelling Foley catheter, after a period of time you may be able to change to a suprapubic indwelling catheter. This is a permanent catheter that is surgically inserted above the pubic bone directly into the bladder. It does not go through the urethra.
- If you can't use intermittent catheterization and can't (or don't want to) use an indwelling catheter, you may be able to choose surgery that creates a urostomy. An opening (stoma) is made between your bladder and the skin of your belly. Urine then drains into a bag attached to your skin at the stoma. Intermittent catheterization can be used through the stoma, if needed.
- For men, a condom catheter can also be used. Condom catheters are only for short-term use, because long-term use increases the risk of urinary tract infections, damage to the penis from friction with the condom, and a block in the urethra.
- If you have a spastic bladder, you may be able to "trigger" the bladder to contract and avoid having to use a catheter. To do this, you can try tapping on the bladder area, stroking your thigh, or doing push-ups in your wheelchair. Or you can use Valsalva maneuvers, which are efforts to breathe out without letting air escape through the nose or mouth.
- It is also possible to use absorbent products, such as adult diapers.
You may use just one method or a combination.
A number of medicines are available to help you manage your bladder. These include:
- Anticholinergics, such as oxybutynin and propantheline, which calm the bladder muscles. They may prevent uncontrollable bladder spasms that force urine out of the bladder.
- Cholinergics, such as bethanechol, which can help the bladder to squeeze, forcing out urine. When cholinergics are used, other medicines may also be used to help relax the muscles that hold urine in the bladder. These include alpha-blockers (for example, terazosin) and botulinum toxin.
Research continues on bladder management. New methods include surgically implanted components that stimulate the bladder through a radio control.
Note: Bladder problems can trigger autonomic dysreflexia, which causes sudden very high blood pressure and headaches. If not treated promptly and correctly, it may lead to seizures, stroke, and even death. These complications are rare, but it's important to know the symptoms and watch for them.